Roach: Essential tremor treatments

Dear Dr. Roach: I have been diagnosed with essential tremor. Propranolol 10 mg has not helped. Sometimes I can write and eat with no shaking, but other times the shaking is so bad that the food falls off the fork or I cannot read my printing or writing. If I drink a beer, it seems to relax me enough that in five minutes I can write or eat quite normally nearly every time. I've been told that it doesn't appear to be Parkinson's. Any suggestions will be enormously appreciated. -- J.N.

Dr. Roach: Essential tremor, sometimes called benign familial tremor, is common. Often, one has a family history of tremor. It is not Parkinson's disease; however, it isn't always "benign" in that, for some people, it can be disabling, preventing a person from not only writing, but, as in your case, activities of daily living such as eating.

Alcohol has long been known to reduce the tremor temporarily, but it must be taken cautiously, since regular use will diminish its effectiveness, requiring higher doses for effectiveness -- and, as I have written many times, excess alcohol is a major cause of many medical problems. Occasional use with meals is reasonable.

Other effective treatments for essential tremor include anti-epilepsy medications such as primidone, gabapentin and topiramate. Unfortunately, all of these can have side effects, so they are best prescribed by an expert, such as a neurologist who specializes in movement disorders.

For serious essential tremor not responsive to medications, deep brain stimulation (via electrodes placed surgically) is effective. We continue to wait for more information on ultrasound treatment.

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